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Old 08-14-2012
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Liver Liver Transplantation Rejection!

Ten days after undergoing liver transplantation, a patient's levels of gamma-glutamyl transferase (GGT), alkaline phosphatase, and bilirubin begin to rise. Which of the following is the most appropriate next step in diagnosis?

a) Measurement of preformed antibody levels
b) Ultrasound of biliary tract and Doppler studies of the anastomosed vessels
c) Liver biopsy and determination of portal pressures
d) Liver biopsy and more detailed liver function tests
e) Liver biopsy and trial of steroid boluses

kindly explain also...
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Old 08-14-2012
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During Liver transplant anastomotic challenges can occur and would result in rapid increases in the mentioned Chemistry panels ...best choice is to do an ultrasound to view biliary tree and doppler for arterial anastomosis....
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Old 08-15-2012
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is the answer B?i thought E.fidel please explain more.why note acute rejection?
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Old 08-15-2012
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Quote:
Originally Posted by sonu.agarwall View Post
is the answer B?i thought E.fidel please explain more.why note acute rejection?
Differentials here also include Acute rejection...BUT...Liver transplant is fraught with failures in biliary tract and vessel anastomosis.....which must be ruled out first (as the tests involved are non-invasive) before doing an invasive test (Liver Biopsy).......Enzymes also mentioned in the vignette are those elevated in biliary pathologies too....

Last edited by stfidel; 08-15-2012 at 03:52 AM.
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I also answered E .....but answer is B......

@stfidel.......is correct........
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